Lymphoreticular System

▪ Lymphoreticular belong to cells or tissues of both

lymphoid & reticuloendothelial system.
▪ It comprised of-
➢ primary lymphoid organs
responsible for the production of lymphocytes,
➢ secondary lymphoid tissue
provide an environment where lymphocytes can
react to antigen from tissue fluid, blood & mucosal
surface.
❖ The main functions of the lymphoreticular system
are removal of senescent(aging) cells & production
of immune cells.
 Lymphoid organ

• Primary- Bone marrow, Thymus-involved in

lymphatic development
• Secondary-Spleen,Lymph node,Tonsil, Adenoid,
Peyer,s patches.
• Tertiary- MALT
 Lymphoid organ

❖ Following initial development from precursors in

bone marrow (B cells) & thymus (T cells),
lymphocytes circulate through blood.
❖ influence of specific cytokines & chemokines, home
to lymph nodes, spleen, tonsils, adenoids & Peyer's
patches, which constitute the peripheral lymphoid
tissues.
 Lymphnode
❖ Lymphnodes are discrete encapsulated spherical or
kidney shaped organ composed of lymphoied
tissue.

❖ They contain well-organized B-cell & T-cell zones.

 Lymphnode
Structures
❖ Connective
tissue capsule
surrounds the
lymph node,
forming
trabeculae into
its interioer.
• Each node
contains -cortex,
para cortex,
medulla & sinus.
 Lymphnode
✓ Cortex- Lymphoid follicles, B cell reactive
zone(germinal centre).
✓ Paracortex-T cell & dendritic cell (Ag presenting
cell)
✓ Medulla
✓ Sinus- containing large number of macrophages
 Lymphoreticular diseases
• Lymphadenitis
• Acute non-specific
• Chronic non-specific
• Neoplasm
• Primary
• Lymphoma
• Leukemias
• Plasma cell neoplasm
• Secondary
❖Generalised lymphadenopathy can be defined as
enlargement of more than two non-contiguous
lymph node groups.

❖ Most generalised lymphadenopathy is due to

benign self-limited disease, such as viral or bacterial
infection but it can be caused by a wide range of
conditions .
Causes of generalized lymphadenopathy

Infection :
• Viral : Infectious mononucleosis,
Infective hepatitis, AIDS
• Bacterial : Tuberculosis, Brucellosis,
secondary syphilis
• Protozoal : Toxoplasmosis
• Fungal : Histoplasmosis
Causes of generalized lymphadenopathy
• Malignant
• Leukaemia
• Lymphoma
• Metastatic carcinoma
• Immunological
• Systemic lupus erythematosus
• Felty's syndrome a triad of
• Drug hypersensitivity rheumatoid arthritis,
splenomegaly, and
• Misc. neutropenia

• Sarcoidosis
• Amyloidosis
 Lymphadenitis
• Acute non specific lymphadenitis
– LN undergo reactive changes when there is microbial
infection.
– Most commonly seen in:
– cervical region due to infection of teeth or tonsils.
– inguinal and axillary region due to infection of
extremities.
 Lymphadenitis

Morphology of acute nonspecific lymphadenitis

• Grossly, the nodes become swollen, gray-red, and
engorged.
• Microscopically, there is prominence of the
lymphoid follicles, with large germinal center.
When pyogenic organisms are the cause of the
reactions, the centers of the follicles undergo
necrosis.
Chronic non specific lymphadenitis
– Pattern
• Follicular hyperplasia
• parafollicular hyperplasia
• Sinus histiocytosis
– Follicular hyperplasia:
✓Stimulation of lymphnode due to humoral
antibody production
✓Occurs most commonly due to immunological
reactions
✓Example: Rheumatoid Arthritis,
toxoplasmosis, AIDS
Follicular hyperplasia
A. Low-power view showing
a reactive follicle and
surrounding mantle zone.
B. High-power view of dark
zone shows several
mitotic figures and
numerous macrophages
containing phagocytosed
apoptotic cells (tingible
bodies).
 Con….
❖ Parafollicular hyperplasia-
✓stimulation of lymphnode due to T cell
mediated immunity
✓Example-Infectious mononucleosis.

❖Sinus histiocytosis-
✓Marked dilatation of sinuses
✓ Many macrophages
✓Lymphnodes draining ca
Sinus histiocytosis
❖ In chronic reaction lymph nodes are nontender,
because nodal enlargement occurs slowly over time.
❖ Chronic lymphadenitis is common in:
inguinal and axillary nodes, which drain large areas
of body & challenged frequently.
❖ Chronic immune reactions can promote organized
collections of immune cells in nonlymphoid tissues.
• Classic example: In chronic gastritis caused by
Helicobacter pylori, in which aggregates of mucosal
lymphocytes are seen that simulate the appearance
of Peyer's patches.
 Lymphoma
Definition
Lymphoma is a malignant neoplasm of lymphoid
tissue which arise as discrete tissue masses.
• Classified into two broad groups-

✓Hodgkin Lymphoma
✓Non-Hodgkin Lymphoma

❖ Majority of lymphoid neoplasms are of B-cell

origin (85% to 90%)
 Causes
❖Chromosomal translocation & other acquired
mutations
❖Inherited genetic factors
❖Viruses
❖Chronic Immune Stimulation.
Ex: H. pylori infection & gastric B-cell lymphoma
❖ Iatrogenic factors.
radiation & chemotherapy
❖Smoking
 Viruses that cause lymphoma

❖HTLV-1:Adult T cell leukemia/lymphoma

❖KSHV/HHV-8: Unusual B cell lymphoma

❖EBV: Burkitt lymphoma, Hodgkin Lymphoma(30%-

40%)
LYMPHOID NEOPLASMS
One confusing aspect lymphoid neoplasms concerns the
use of the terms lymphocytic leukemia and lymphoma.
Leukemia is used for neoplasms that present with
widespread involvement of the bone marrow and the
peripheral blood.
Lymphoma is used for proliferations that arise as discrete
tissue masses.

❖ Many entities called "lymphoma" occasionally have leukemic

presentations, and evolution to "leukemia" is not unusual during
the progression of incurable "lymphomas." Conversely, tumors
identical to "leukemias" sometimes arise as soft-tissue masses
unaccompanied by bone marrow disease.
 Clinical difference between Hodgekin & non-Hodgkin
lymphoma
Hodgkin Lymphoma Non-Hodgkin Lymphoma
More often localized to a More frequent involvement
single axial group of nodes of multiple peripheral nodes
(cervical, mediastinal, para-
aortic)
Orderly spread by contiguity Noncontiguous spread
Mesenteric nodes and Waldeyer ring and
Waldeyer ring rarely involved mesenteric nodes commonly
involved
Extra-nodal presentation rare Extra-nodal presentation
common
 Hodgkin lymphoma

• Definition:It is a group of lymphoid neoplasm

characterizes by the presence of neoplastic giant
cell called Reed-sternberg cells.
• Criteria
– Most often localized to a single axial group of
lymph node
– Spread by contiguity
– Age: Young adults & adolescent(average-32y).
 Hodgkin lymphoma

❖ Classification
WHO classification recognizes five subtypes of HL-
❖Classical subtypes
• Nodular sclerosis
• Mixed cellularity
• Lymphocyte-rich
• Lymphocyte depletion

❖ Lymphocyte predominance
 Con……
• Clinical features
– Enlarged non tender lymph node(often >2 cm)
– Fever
– Weight loss
– Night sweats
– Decreased immunity
• Treatment: Radiation & chemotherapy
• Prognosis: Usually curable.
• Reed Sternberg cell(RS
cell)
▪ Def: It is a neoplastic giant
cell found in HL.
▪ Morphology:
– Large cells(>45 micro
meter)
– Multiple nuclei or a
single nucleus with
multiple nuclear lobes
each with a large
inclusion like nucleolus
– Cytoplasm is abundant
Types of RS cell

▪ Diagnostic RS cell
▪ Mononuclear
variant
▪ Lacunar cell
▪ Lymphohistiocytic
variant
Reed-Sternberg cells &
variants
❖ Diagnostic RS cell
➢ two nuclear lobes large
inclusion-like nucleoli
➢ abundant cytoplasm,
lacunar variant
➢ folded or multilobated
nucleus & lies within a
open space, which is an
artifact created by
disruption of the
cytoplasm during tissue
sectioning.
Reed-Sternberg cell
❖Mononuclear variant
❖Lymphohistiocytic
variant
➢ Infolded nuclear
membrane
➢ small nucleoli,
➢ abundant pale
cytoplasm
Nodular sclerosis
• Characterized by presence of frequent lacunar cells
& occasional diagnostic RS cell.
• Deposition of collagen in bands that divide involved
lymph nodes into circumscribed nodules.
• RS cells are found in a polymorphous background of
T cells, eosinophils, plasma cells & macrophages.
• Nodular sclerosis type occurs with equal frequency
in males & females.
• Prognosis is excellent.
• Mixed cellularity
• Frequent mononuclear and diagnostic RS cells; background
infiltrate rich in T lymphocytes, eosinophils, macrophages,
plasma cells;
• Lymphocyte rich Frequent mononuclear and diagnostic RS
cells; background infiltrate rich in T lymphocytes;
• Lymphocyte depletion : Frequent diagnostic RS cells &
variants and a paucity of background reactive cells;

• Lymphocyte predominance
• Frequent L&H (popcorn cell) variants in a background of
follicular dendritic cells and reactive B cells;
• Most common form of HL(65% to 70%)
•
 Con….
• Prognosis:
– Excellent: NS, LP, LR
– Very good to good: MC, LR
– Bad prognosis: LD
• Spread:
– Nodal-spleen-liver-BM and other tissue.
• Clinical staging
• Ann Arbor Classification(Depending on Physical &
Radiological examination & biopsy of BM)
• For Rx and prognostic purpose.
• What do you mean by generalized
lymphadenopathy?
• Tell the causes of lymphadenopathy.
• How will you diagnose a case of
lymphadenopathy?

• What is lymphoma?
• What are the types of lymphoma?
• State the differences between them.
• Classify Hodgkin lymphoma.
• State the morphology of classic Reed-
Sternberg cell.
• What are the variants of RS cell?
Short note
a. Burkit lymphoma b.NS varient of HL